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HomeMy WebLinkAbout150588 WALSH CONSTRUCTION INC - INSURANCE CERTIFICATE (9)OP ID: SC ,d►1* R CERTIFICATE OF LIABILITY INSURANCE DAT06106112vY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this _certificate_ does not confer rights to the _ certificate holder in lieu of such endorsements . PRODUCER 970-223-1804 CONTACT Front Range Insurance Group 1100 Haxton Drive Suite 100 Fort Collins, CO 80625 David A. Wooldridge LUTCFAAI ti-r pl PHONE FAX INC. No Eat: INC, No: E-MAIL ADDRESS: PRODUCER WALSH4 CUSTOMER,,,, INSURERS AFFORDING COVERAGE NAICk INSURED Walsh Construction, Inc. INSURER A: Plnnacol Assurance 41190 Matthew Walsh, Pres. INSURER B: Builders Insurance Group 8139 Open View Place Loveland, CO 80537 INSURER c INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE N L UB POLICY NUMBER POLICY EFF MMIODNYYY POLICY EXP MMI DDIYYYY LIMITS B GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I —XI OCCUR X PKGO10429102 06101/12 06/01/13 EACH OCCURRENCE $ 1,000,00 PREMREM RENT D ISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL S ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE _X1 PO'UCV LIMIT APPLIES PER: PRO LOC PRODUCTS - COMPIOP AGG $ 2,000,00 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS MIRED AUTOS NON -OWNED AUTOS - COMBINED SINGLE LIMIT (Ea amident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE UMB011984901 O6IOtN2 06/01/13 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEY/N OFFICERNEMBER EXCLUDED? F1 (Mandatory 1n NH) If yes, deambe under DESCRIPTION OF OPERATIONS below NIA 4104361 05/01/12 05101/13 WC STATU- X OTH- EL.EACH ACCIDENT $ 1,000,00 E. L. DISEASE - EA EMPLOYEE $ 1,000,00 E. L. DISEASE -POLICY LIMIT $ 1,000,00 B Inland Marine PKGO10429102 06101112 06/01/13 Sch Equip 220,20 Leas/Rent 50,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101. Additional Remarks Schedule, If more space Is required) City of Ft. Collins is listed as an Additional Insured with regards to the General Liability policy. CITYOFF City of Fort Collins Attn: Purchasing P.O. Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD OP ID: SC A4c"RO" CERTIFICATE OF LIABILITY INSURANCE DAT06/06/12YY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER 970-223-1804 CONTACT - FrontRangelnsurance Group - 1100 Haxton Drive Suite 100 Fort Collins, CO 80525 David A. Wooldridge LUTCFAAI PHONE FAX ac o rt ,C'No : EMAIL ADDRESS: PRODUCER WALSH-4 CUSTOMER ID INSURERS AFFORDING COVERAGE NAIC 0 INSURED Walsh Construction, Inc. INSURER A: Pinnacol Assurance 41190 Matthew Walsh, Pres. INSURER B: Builders Insurance Group 8139 Open View Place Loveland, CO 80537 INSURER C INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE A UB POLICY NUMBER MMDDNYYY MMIDDNYYY LIMITS B GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CI-AIMS�DE aOCCUR X PKGO10429102 - 06/01112 06/01113 EACH OCCURRENCE $ 1,000,00 PREMREM T RENTED ISES Ea occurrence)$ 100,00 MED EXP(Any one Person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN1 AGGREGATE LIMIT APPLIES PER X1 POLICY PRO PRODUCTS - COMPIOP AGG $ 2,000,00 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ B X UMBRELLA LIAB EXCESS LAB X OCCUR CLAIMS -MADE UMB011984901 06101/12 06101113 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ DEDUCTIBLE $ $ F-IRETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOWPARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? ❑ (Mandatory In NH) If yes, descuthe under DESCRIPTION OF OPERATIONS below NIA 4104361 05101/12 05/01/13 WC STATU- X OTH- E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE -POLICY LIMIT 1 $ 1,000,00 B Inland Marine PKGO10429102 06/01/12 06/0V13 Sch Equip 220,20 Leas/Rent 50.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Project: Fossil Creek Trail at Stanton Creek Bid #7289 City of Fort Collins is listed as Additional Insured with respect to the General Liability policy. City of Fort Collins Purchasing PO Box 580 Fort Collins, CO 80522 CITYOFF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/09) © 1988-2009 ACORD The ACORD name and logo are registered marks of ACORD All riahts reserved